THE ABILITY OF THE ‘SCORE’ RISK MODEL TO PREDICT 10-YEAR CARDIOVASCULAR DISEASE MORTALITY: CANADIAN HEART HEALTH SURVEYS (CHHS) FOLLOW-UP STUDY AS AN EXAMPLE

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Abstract

The purpose of this study is to evaluate the predictive accuracy of the SCORE (Systematic COronary Risk Evaluation) risk prediction model to predict the risk of 10-year cardiovascular disease (CVD) mortality in Canadian Heart Health Surveys (CHHS) Follow-up Study population.
The study used data from The Canadian Heart Health Surveys (CHHS) Follow-up Study which is a linked dataset of Canadian Heart Health Surveys (1986-1992), a baseline cross-sectional complex surveys and Canadian Mortality Database by Statistics Canada. SCORE CVD risk prediction models for both high- and low-risk regions were used to calculate the predicted deaths from cardiovascular disease over a period of 10-year for both men and women aged 40-69 years with no previous history of cardiovascular disease. The predicted number of deaths was compared with observed CVD deaths (stratified by age and sex) in the CHHS Follow-up Study population. .
Over a period of 10-year, the observed absolute risk of cardiovascular death in CHHS population was found to be 1.9% (95% CI: 1.87, 1.92) in male and 0.9% (95% CI: 0.87, 0.90) in female. By using SCORE high-risk model, the observed vs. expected death (O/E) ratio was found to be 0.54, 0.34, 0.49 in men and 0.55, 0.52, 0.50 in women respectively for the age group 40-49, 50-59 and 60-69 years. The SCORE low- model predicted O/E ratio of 1.06, 0.63, 0.87 in men and 0.88, 0.80, 0.75 in women respectively for age group 40-49, 50-59, and 60-69 years. Twenty-eight percent of males and seven percent of females were identified to have a risk of 5% or more of having a fatal CVD event within next 10 years by the SCORE high-risk model and the same was found to be in 12% of males and 5% of females respectively by the SCORE low-risk model.
Application of the original SCORE models for high- and low-risk regions in Canadian Heart Health Survey Follow-up Study data has resulted in over prediction of the number of CVD deaths. SCORE low-risk model performed better than the high-risk version. Recalibration of SCORE risk prediction model is suggested if it is considered to be used in Canada.